Hospitals on the rebound, show stronger operating margins

Hospitals in the U.S. have rebounded from the Great Recession and are showing stronger operating margins than in years past, even as more care shifts from inpatient to outpatient.

Those findings from the American Hospital Association's annual Hospital Statistics guide—which includes data from fiscal 2012—show that the nation's acute-care providers are delivering more care in emergency room and outpatient settings as the number of inpatient days, inpatient surgeries and births continues to decline. The findings were released exclusively to Modern Healthcare.

At the same time, inpatient beds per capita have remained steady at 2.6 per 1,000 people—unchanged since 2009—and the average length of stay has remained consistent at 5.4 days.

The trends also are accelerating. In 2012, emergency department visits increased 2.9% over the previous year, compared with 1.7% between 2011 and 2010.

Outpatient visits also increased nearly 2.9% to almost 675 million, compared with year-over-year growth of just 0.7% between 2010 and 2011.

The numbers also confirm what executives have noticed for some time: fewer patients are being treated on medical/surgical floors. In 2012, hospitals saw 34.4 million admissions, a decrease of 1.2% from 2011. That's a somewhat bigger drop-off than the 0.9% between 2010 and 2011 and the 1.1% between 2009 and 2010.

Nevertheless, hospitals reported $821.3 billion in total net revenue in 2012, compared with $755.3 billion the previous year, and $730.9 billion in 2010. “I think hospital revenue did rebound somewhat due to the economy,” said Caroline Steinberg, vice president of health trends analysis.

At the same time, the level of uncompensated care continued to grow, with hospitals spending 6.1% of their expenses, or a record $45.9 billion, on bad debt and charity care.

Despite fears that the challenging operating environment would lead hospitals to close their doors, the total number of hospitals remained steady—even increasing slightly to 4,999 from 4,973. In comparison, there were 5,010 hospitals in 2008.

Yet it's evident that consolidation has brought more hospitals into systems: there were 3,100 hospitals that were part of a system in 2012 compared with 3,007 in 2011 and 2,868 in 2008.

At the same time, fewer hospitals are part of group purchasing organizations: 3,519 in 2012 compared with 3,562 the previous year, and 3,677 in 2008.

The numbers also show that hospitals are contributing more to the nation's economy. Acute-care facilities employed 5.6 million people in 2012, 1.5% more than the previous year, and about 800,000 more than a decade earlier.

Hospital employees comprise anywhere from 3.3% of the workforce in the mountain states to 5.1% in New England. Only full-service restaurants employ more people.

“The healthcare sector continues to grow and hospitals are a big part of that,” Steinberg said, adding that hospitals are trying to bolster their nursing and technical staff, with the latter to prepare for changes such as meaningful use and the implementation of ICD-10.

While 2012 data suggested hospitals were gearing up for healthcare reform through integration and affiliation, Steinberg said she expects to see more hospitals preparing to participate in insurance exchanges in 2013. “We're still not seeing formation of insurance products,” she said.

One thing the survey did see was a big increase in high-deductible health plans, which could increase bad debt if patients can't afford their share of the bill. “That will be a significant impact on hospitals,” Steinberg said.